The Health Policy Project has ended, but work continues under a new USAID five-year project, Health Policy Plus (HP+).

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Building Afghanistan's Capacity to Improve Healthcare Efficiency and Sustainability

Health Policy Project

Mr. Mohammad Zawoli is shown near his village in the eastern province of Ghazni in Afghanistan. Zawoli is one of seven staff members of the Health Economics and Financing Directorate of the Afghanistan Ministry of Public Health who completed a master’s degree in health economics with support from the USAID-funded Health Policy Project. The graduates are working to improve the efficiency and financial sustainability of Afghanistan’s health systems.

December 6, 2013

KABUL, Afghanistan – In 1979, the year the Soviets invaded Afghanistan, Mohammad Zawoli was born in a village in the eastern province of Ghazni. Throughout the war-torn years of his childhood, a time when many Afghans lost access to even basic education, Zawoli learned to read from his family’s library of religious books, and enrolled in a local school that reopened when he was 12. He let nothing get in the way of his education, and eventually graduated with a degree in macroeconomics from Kabul University.

Zawoli recently achieved a new educational goal: a master’s degree in health economics and healthcare management. His employer, the Health Economics and Financing Directorate (HEFD) of the Afghanistan Ministry of Public Health (MOPH), sponsors a work-study program for HEFD staff to obtain a master’s in health economics with support from the Health Policy Project, which is funded by the U. S. Agency for International Development (USAID). The program’s objective, in line with USAID’s commitment to individual and organizational capacity development, is to support Afghan health economists as they learn to generate the data and provide the leadership needed to improve the efficiency and financial sustainability of Afghanistan’s fragile health systems. Required courses for the program include micro- and macroeconomics, healthcare finance, research and evaluation methods, and more, taught in English.

Based at Thailand’s Chulalongkorn University, the two-year graduate program allowed Zawoli and six other HEFD staff to rotate study in Bangkok with their work back home. Returning every few months to Afghanistan, the seven participants trained their colleagues as they used their new knowledge and skills to guide both old and new projects.

“Working and studying together was interesting for me because what I learned I could apply immediately,” said Zawoli.

Building Expertise

During the decades of war, many Afghan health professionals fled the country, and prolonged shelling destroyed clinics and hospitals. Recovery has been slow: many of the surviving facilities are under-equipped and -staffed, while even basic health services are scarce and, in some places—particularly rural areas—nonexistent. It’s not surprising that some of Afghanistan’s basic health indicators, such as rates of maternal and child mortality, are among the worst in the world.

As Afghanistan continues to build its health infrastructure and services, Zawoli is deeply aware of the need to develop expertise from within rather than continuing to depend on external technical support. His next goal is to become a professor at an Afghan university so he can train a new generation of public health professionals.

“We need to localize what we learned abroad,” he said. “Since most experts [who left the country] won’t come back, we need to bring that knowledge to the country [to achieve] a longer and larger impact.”

The seven HEFD staffers graduated in May 2013, and are contributing to Afghanistan’s evidence base by conducting efficiency studies in district and regional hospitals, performing cost comparisons of public and private paramedical institutions, and analyzing financing projects. Zawoli’s master’s thesis focused on cost analysis of two regional hospitals, and his data are informing HEFD efforts to advocate for evidence-based policies to increase efficiency in staffing and procurement at regional hospitals.

The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA).

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